Imprisoning the Mentally ill

This is from Patrick Cockburn, award winning war correspondent with the i paper. It seems a far cry from his usual topic, but not really.

The criminalisation of the mentally iill is one of the cruellest and most easily avoidable tragedies of our era. He discusses a number of cases of impending executions for the mentally ill,in the USA, then this:

Between 1955 and 2016, the number of state hospital beds in the US available for psychiatric patients fell by over 97% from 559,000 to just 38,000.

Stop for a moment and think about that. Think about the cruelty to patients and the danger to the public of them being untreated, to be left alone with their disturbed thoughts. Think of how many serial killers took innocent lives because they were denied help. Cockburn continues: 

Those who are not in prison or hospital “Become violent or, more often, the victims of violence. They grow sicker and die. The personal and public costs are incalculable,” says a report by the Treatment Advocacy Centre in Virginia.

Mentally ill people, usually poor and unemployable because of their condition, are sometimes advised that the only way they will get even the crudest treatment is by being sent to prison.

The same process is happening in Britain. One of the justifications for closing down the old asylum system was that they were too much like prisons, but the paradoxical result has been that psychiatric patients are now ending up in real prisons.

The number of beds available for mental health patients in the UK has dropped by 3/4 since 1986-87 to about 17,000, while the Centre for Mental Health says that 21,000 mentally ill people are imprisoned making up 1/4 of the prison population.

Deceptively progressive sounding words, like “deinstitutionalisation” (US) and “care in the community” (UK) are used to describe the ending of the vast system that once catered for psychiatric patients.

Some of these institutions were hellholes, and others became unnecessary because medication was available from the 1950s that controlled some of the worst symptoms of mental illness. But the old system did at least provide an asylum in the sense of being a place of safety where people who could not look after themselves were cared for.

This is important. drugs known as ‘mental straight jackets’ have restrained the violent, but it numbs them. They talk in monotones, they struggle to manage their lives, so become isolated. Also mentally ill are not great at remembering to do things, so sticking to a drug regime is difficult, so treating them is hard when it is impossible to assess whether it is the drugs or lack of them that are the problem.  I used to know a guy who made deliveries to Broadmoor, the high security mental health institution. We all have images of such places as being like Bedlam, of banging and screaming, but the inmates are all drugged to the hilt. The place is apparently spookily quiet.

The reality of the new system was best described by the detective-story writer PD James, whose husband was a long-term patient in a mental hospital. She wrote that since the 1970s community care “could be described more accurately as the absence of care in a community still largely resentfulness.”

Little has improved since James was writing, as was made plain this week by a report by Sir Thomas Winsor, the Chief Inspector of Constabulary, who complained that the police are increasingly being used as the “first resort” for people with mental health problems. He said that sometimes they ended up spending the night in police cells even though they had committed no crime because no hospital beds were available. The “inadequacy” of mental health provision, he said, should “disturb everyone”.

When I first began to write about schizophrenia in 2002, I found that my friends and relatives divided into those who knew nothing about mental illness and those who knew all too much about it. The latter had often never mentioned previously that they were looking after a sister with schizophrenia or a brother who could not leave his flat without having a breakdown. One friend disclosed a terrible story of a sister-in-law who had poured petrol over herself and set it alight, suffering burns over 3/4 of her body from which she took weeks to die in agony.

Openness and discussion are important, but they skirt the heart of the problem, which is that a proportion of people who are mentally ill cannot look after themselves. Schizophrenia, for instance, is to mental illness what cancer is to physical illness. when Prince Harry talks about psychological problems, we must remember they are still not the same as full-blown psychosis or, in other words, madness.

The present system has failed and the result is the creeping criminalisation of madness. The only way to reverse this is to build a core of dedicated hospitals that will care for and protect psychiatric patients who cannot do this for themselves and are a potential danger to themselves and to others.

Mental health is difficult for governments and communities to deal with as it is so hard to assess. A broken leg can be fixed, the results clear, but mental illness is harder to detect, harder to measure results. The Victorian asylums were flawed, but they often allowed access to the countryside, which lifts patients spirits. Just escaping from bad environments can be therapeutic. But there is no respite care for people being driven mad by modern life.

Institutions can help defray costs. Many patients can do gardening and cooking as part of their therapies; it gets them active, helps them interact with others, and they can leave with useful skills. It has to be preferable to the high costs of criminalisation.

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